Level of Oversight For Life and Death Decisions

Key moral questions come straight into focus when you read about a case where judgement was handed down today regarding the withdrawal of life saving food and water from a person in a persistent vegetative state.

Despite the person dying before the judges reviewed the case it was decided that it was important that precedent was set for future such situations.

Vegetative State

If you are in a vegetative state it means that you are awake but you do not show signs of awareness.

This means that you might open your eyes, breathe and respond to some touch or noise but do not give meaningful responses or show signs of experiencing emotion.

A lot of brain injured people end up in a permanent vegetative state. Almost all of them never come out of it.

Difficult Decision

The amount we know about the brain is severely limited… the amount we know about life itself… well…

To make matters even more difficult, the person in the permanent vegetative state has no ability to communicate what they would want to happen, so there needs to be a decision by other people on their behalf – judges, doctors, family members – about what should be done. Whether life should be prolonged or food and hydration should be stopped.

Suffice to say it is an incredibly complicated area where opinions, facts, morals and beliefs all weigh in and judgements should be carefully scrutinised.

The reality of the decision handed down today is that if two doctors agree and “the family” is fine with it, then the court only needs to get involved if someone objects. The requirement for the second doctor to be independent of the first is restricted to only if it is “reasonably practicable”.

My View

I am concerned by some of the reasoning employed in coming to this decision, as I would with any decision that cites lack of resources in the NHS or court system – which surely represent political issues not legal or moral ones?

The argument that doctors make life or death value judgements all the time is not a particularly reassuring one either. This situation is very different from one where a decision is made to withdraw CPR.

My view is that if such a big decision is going to be made on behalf of someone who can’t speak for themselves then it should be open to public scrutiny.

I accept that running all such decisions through the Court of Protection, perhaps might not be the best way to make them, but that does not mean the lack of oversight set down in as acceptable in this judgement is enough to safeguard people who are in a persistent vegetative state.

Tom Lax is a senior solicitor in the Adult Brain Injury team at Bolt Burdon Kemp. If you or a loved one are concerned about the treatment you have received, contact Tom free of charge and in confidence on 020 7288 4840 or at TomLax@boltburdonkemp.co.uk. Alternatively, complete this form and one of the solicitors in the Medical Negligence team will contact you. Find out more about the Adult Brain Injury team.